Estimating Hepatitis C Virus Prevalence in US States and the District of Columbia, 2017-2020
- 1Emory University
Abstract
BackgroundState-level estimates of hepatitis C virus (HCV) prevalence are needed to guide resource allocation and to provide a baseline against which to measure progress toward elimination goals. Population prevalence is not directly observable, requiring estimation from indirect data sources.
MethodsWe adapted a Bayesian spatial integrated abundance model to estimate state-level HCV prevalence during 2017-2020 across 48 states and the District of Columbia. The model integrated six HCV-related outcomes: acute and chronic surveillance cases, HCV-related deaths, observations of HCV in [MarketScan] administrative claims data, diagnoses of HCV in Medicaid recipients, and treatment with direct-acting antivirals in Medicaid recipients. Estimates were anchored to a national prevalence estimate, and the model accounted for data source-specific selection, heterogeneity in HCV risk factors across states, and geospatial correlation.
ResultsEstimated average prevalence was 1.32% (95% credible interval [CrI]: 0.94%-1.80%), corresponding to 3.33 million (95% CrI: 2.37-4.65 million) adults with HCV infection across 48 states and DC. State estimates ranged from 0.74% in North Dakota to 2.22% in Oklahoma (median state-specific prevalence, 1.27%), with higher prevalence concentrated in South Central states, Appalachia, and the West, and the lower prevalence in the upper Midwest, Southeast, and New England. Ten states accounted for 56% of estimated infections. Estimates were stable in sensitivity analyses (most differences <1 percentage point).
ConclusionsThese estimates quantify state-level HCV burden prior to the 2021 federal expansion of HCV surveillance funding, providing a baseline for monitoring elimination progress. Geographic variation indicates that resource needs will differ by jurisdiction.
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BibTeX
@misc{bradley2026estimating,
title = {{Estimating Hepatitis C Virus Prevalence in US States and the District of Columbia, 2017-2020}},
author = {H. Bradley and Y.-H. Yu and L. Li and S. N. Kapadia and P. S. Sullivan and E. W. Hall},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.29.26364309},
url = {https://www.medrxiv.org/content/10.64898/2026.09.29.26364309v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Estimating Hepatitis C Virus Prevalence in US States and the District of Columbia, 2017-2020
AU - H. Bradley
AU - Y.-H. Yu
AU - L. Li
AU - S. N. Kapadia
AU - P. S. Sullivan
AU - E. W. Hall
PY - 2026
DA - 2026/09/29
PB - medRxiv
DO - 10.64898/2026.09.29.26364309
UR - https://www.medrxiv.org/content/10.64898/2026.09.29.26364309v1
AB - BackgroundState-level estimates of hepatitis C virus (HCV) prevalence are needed to guide resource allocation and to provide a baseline against which to measure progress toward elimination goals. Population prevalence is not directly observable, requiring estimation from indirect data sources. MethodsWe adapted a Bayesian spatial integrated abundance model to estimate state-level HCV prevalence during 2017-2020 across 48 states and the District of Columbia. The model integrated six HCV-related outcomes: acute and chronic surveillance cases, HCV-related deaths, observations of HCV in [MarketScan] administrative claims data, diagnoses of HCV in Medicaid recipients, and treatment with direct-acting antivirals in Medicaid recipients. Estimates were anchored to a national prevalence estimate, and the model accounted for data source-specific selection, heterogeneity in HCV risk factors across states, and geospatial correlation. ResultsEstimated average prevalence was 1.32% (95% credible interval [CrI]: 0.94%-1.80%), corresponding to 3.33 million (95% CrI: 2.37-4.65 million) adults with HCV infection across 48 states and DC. State estimates ranged from 0.74% in North Dakota to 2.22% in Oklahoma (median state-specific prevalence, 1.27%), with higher prevalence concentrated in South Central states, Appalachia, and the West, and the lower prevalence in the upper Midwest, Southeast, and New England. Ten states accounted for 56% of estimated infections. Estimates were stable in sensitivity analyses (most differences <1 percentage point). ConclusionsThese estimates quantify state-level HCV burden prior to the 2021 federal expansion of HCV surveillance funding, providing a baseline for monitoring elimination progress. Geographic variation indicates that resource needs will differ by jurisdiction.
ER -